CIHI’s Annual
Report,
2015–2016Charting a New Course

David O’ToolePresident and CEO

Brian PostlBoard Chair

Message from CIHI’s Board chair and
president

Throughout 2015, our Board of Directors, our executive leadership and
our employees considered the role our organization should play in the
health sector in Canada in the next 5 years. We consulted extensively
across Canada to develop a renewed mandate and vision for CIHI —
one that reflects the evolution of health information needs in this
country and that will take us into the next decade.

Moving forward together

The Board of Directors of the Canadian Institute for Health Information (CIHI) recently
approved our new strategic plan, setting out our direction to 2021. We have a renewed
mandate, goals and priorities, all linked by our commitment to meaningful engagement
with the people and organizations we work with across the country.

This annual report highlights what we accomplished in 2015–2016 and the impact that CIHI
is making across Canada, and it sets the stage for our new direction for the next 5 years.

We have an ambitious plan to help transform and accelerate improvements in health care,
health system performance and population health across the continuum of care.

The health information landscape has changed significantly since CIHI began in 1994, and
we are changing with it. Inevitably, the priorities of our partners will shift, the availability of
resources will fluctuate, and the technologies of health care and health information will evolve.
But the essential themes and direction set out here will continue to guide our thinking and
decisions as we manage those developments.

Better data. Better
decisions. Healthier Canadians.
We look forward to working with our stakeholders as
we take action and deliver this plan.

Dr. Brian Postl
Board Chair

David O’Toole
President and CEO

CIHI data in action

It was a year of consultation at CIHI as we moved from
the 3 strategic goals that have guided us for the past
several years to our refreshed strategic directions that
look to the future. We have worked closely with our
stakeholders and our staff to plan for our future.

This annual report provides a snapshot of what we
accomplished over the past 12 months, according
to our original goals:

1Improve the comprehensiveness,
quality and availability of data

We will provide timely and accessible data connected across health sectors.

We will support new and emerging data sources, including electronic health records.

We will provide more complete data in priority areas.

2Support population health and health system decision-making

We will produce relevant, appropriate and actionable analyses.

We will offer leading-edge performance management products, services and tools.

You ask. We answer.

At CIHI, we continually strive to improve access to our data and information. Over the past
few years, we’ve implemented a successful strategy for enhancing access to health system performance data through our Your Health System web tool and
its In Brief, In Depth and Insight sections. Data
related to
international comparisons and patient costs has also been made available through our new web tools and products.

There are other ways in which to access
CIHI’s data. Ann Chapman, Manager, Programs
Strategic Initiatives, explains a few of them:

Who requests data from
CIHI?

More than 200 organizations receive CIHI data through the
custom data request process each year, including health delivery organizations, government organizations and educational institutions. We also provide access to CIHI data free of charge to qualifying
graduate students to help build capacity in health service research.

What are the different ways in which
someone can access CIHI data?

CIHI collects comparable, pan-Canadian data on various aspects of Canada’s health
systems — from hospital, community and specialized care to pharmaceuticals, patient
safety, the health workforce, spending, international comparisons, and access and wait
times. This data is carefully maintained and organized in CIHI’s many data holdings so that
it’s retrievable, informative and reusable over time. One way to access this data is through
our public-use dashboards and web tools such as Your Health System, which allow users
to easily view and filter information according to their needs. There are many examples of
these types of public-use tools on our website.

What has CIHI done to assist researchers who want access to CIHI data?

Researchers can submit a request to CIHI for aggregate and record-level data. Usually,
CIHI makes its data available once all of the submissions for a database have been
received for a scheduled period of time (a fiscal year or calendar year, for example). This
year, we began offering access to open-year data — data from a database that may still be
receiving data. This data request program is available to researchers, as well as to health
delivery organizations, government organizations and educational institutions.

Researchers are also able to access sample files of CIHI’s acute care data through
Statistics Canada’s Data Liberation Initiative and its network of post-secondary institutions.
And researchers who are funded by the Canadian Institutes of Health Research (CIHR)
under the pan-Canadian Strategy for Patient-Oriented Research (SPOR) initiative have
access to data sets focused on high users of health care.

We continued to make available and enhance web tools that allow users to examine the performance of health systems and to inform international comparisons.

Working with the Canadian Association of Paediatric Health Centres (CAPHC), we focused on child and youth health by helping create a set of updated pediatric dashboards on emergency department visits, and on wait times for emergency department asthma visits and for surgeries.

We made it easier for users to access the data tables behind all of our analytical products.

We made some of CIHI’s data available through the federal government’s Open Data initiative.

Surveying our data

Quality data is at the heart of everything we do at CIHI, and we take our leadership role in this
area seriously.

Over the past year, we have been developing data surveillance techniques similar to those
used in the finance and insurance sectors. We are looking for any anomalies or outliers that
will help us identify potential data quality issues.

Building on our existing strong culture of data quality, we are evolving our quality management
practices to meet the needs of changing environments.

Streamlining from 4 to 1

In May 2015, CIHI took 4 systems that were 15 years old and integrated them into 1 new
Classifications Information Management System. It’s all about making data collection easier
for our clients: the new system reduces the burden of data collection. A great example of this
is the development and maintenance of pick-lists, which capture specific information at the
point of care.

On a related note, CIHI, Statistics Canada and similar organizations in other countries are
actively contributing to World Health Organization (WHO) activities by providing input into
International Statistical Classification of Diseases and Related Health Problems, 11th Revision
(ICD-11) content and the new coding rules to support its use. We want to ensure that this new
standard will meet Canada’s needs.

Real-time nursing data

If you can’t measure it, you can’t improve it. That’s the theory behind Canadian Health
Outcomes for Better Information and Care (C-HOBIC). C-HOBIC generates real-time
reports that link data on staffing, finance, length of stay and readmissions. This information
can help an organization assess performance and clinical outcomes. At a research level,
the data can help answer questions about the impact of nursing practices on broader
clinical practice. At the health care system level, C-HOBIC empowers better health system
management decision-making as information is shared across practice settings.

C-HOBIC is a standardized data set that captures 48 different patient measures —
24 on admission and 24 on discharge. The measures are calculated using data CIHI
already collects in the Discharge Abstract Database (DAD), supplemented by additional
information gathered through Special Project fields. To date, 2 pilot acute care sites in
Ontario and Manitoba have signed on to collect data to support C-HOBIC’s evaluation.

More and better data

CIHI will enhance the scope, quality and timeliness of our data holdings. There are
5 dimensions of data quality: accuracy, timeliness, comparability, usability and relevance.

Comprehensiveness of CIHI’s data
holdings

CIHI is working to enhance the scope and availability of our data for analysis and
decision-making. The table that follows provides a snapshot of the comprehensiveness
of CIHI’s 31 pan-Canadian data holdings.

10 of CIHI’s data holdings are receiving complete data
from all provinces and territories. An additional
4 have 100% jurisdictional participation when
submissions of partial data are considered.

18 of the data holdings have 80% or more participation
from provinces and territories, and 12 noted progress
toward increased uptake by jurisdictions compared
with the previous fiscal year.

What’s new

1 new data holding was added this fiscal year — the Canadian Patient Experiences
Reporting System (CPERS). 4 jurisdictions — New Brunswick, Ontario, Manitoba and
Alberta — are preparing to submit data in 2016–2017, with 2 more in discussion to
submit data.

New data and analytical components were added to the National System for Incident
Reporting to support the pilot project for tracking and reporting on incidents related to
radiation therapy. 16 cancer centres were registered and approximately 300 radiation
therapy incidents were submitted this fiscal year.

An easier approach to data collection and
submission

On April 1, 2015, the new customizable National Ambulatory Care Reporting System
(NACRS) Clinic Lite application was launched to make it easier to submit clinic data
to CIHI and to enrich CIHI’s outpatient data supply. CAPHC’s Paediatric Rehabilitation
Reporting System adopted NACRS Clinic Lite for data collection and submission, and
the Ontario Ministry of Health and Long-Term Care is sponsoring a NACRS Clinic Lite
pilot for outpatient rehabilitation visits.

Data collection for the Canadian Organ Replacement Register (CORR) was simplified
and streamlined by switching from paper- to web-based data submissions. More than
115 users were given access to submit data using the new secure web form in 2015–2016, including
facilities that had not submitted CORR data for several years. Better data quality and more
efficient data handling resulted in improved timeliness and reporting of organ
replacement information.

Increased availability of data

Among the data holdings that noted progress or plans toward increased data availability
and uptake by jurisdictions compared with the previous fiscal year were the databases or
reporting systems for ambulatory care (emergency department data), rehabilitation, home
and continuing care, incidents, patient costs, and physicians and other health workforce
personnel. CIHI also continued to receive and work with a growing set of patient-level
physician billing data.

CIHI is reducing the burden of data collection and filling data
gaps through increased availability of data in a standardized
and comparable fashion that supports decision-makers and
other health care stakeholders.

Confronting a public health crisis

Prescription drug abuse (PDA) is considered a public health crisis. That’s why Health
Canada asked CIHI to lead a program to improve pan-Canadian data on the issue, including
developing standards and indicators, and identifying and enhancing data sources. The goal
is to support a coordinated approach to monitoring and surveillance. Work on the program
so far includes the following:

We’ve extensively engaged with stakeholders to identify their priority needs. This
exercise, which included a scan of PDA-related programs and information, led us to
develop materials to support PDA-related research using CIHI data; it also formed the
basis of the initial draft of Priorities for Pan-Canadian PDA Monitoring and Surveillance,
which articulates key policy questions and provides sample indicators. This document
will help guide PDA work in Canada for years to come.

We’re supporting Health Canada’s development of the Canadian Surveillance System
for Poison Information. We’re providing input on data standards and system requirements
as the country moves toward national collection of poison control centre information.

In October 2015, CIHI hosted a face-to-face consultation with coroners and medical
examiners to help draft guidelines for investigating and classifying drug-related
deaths. We are pleased to be working with Nova Scotia’s chief medical examiner,
Dr. Matthew Bowes, on this project, and we anticipate that the draft guidelines will
be endorsed at the next national meeting of chief coroners and medical examiners.

Finally, CIHI is leading the first study to look at pan-Canadian trends in
hospitalization — and emergency department visits, where there is sufficient
data — due to opioid poisoning. The results will fill an immediate information gap
in research and policy, while establishing a baseline for subsequent analyses.

Quality data yields quality results

CIHI’s Canadian Patient Cost Database provides detailed patient-level data for a facility.
When a patient leaves the hospital, there is a record of all of the costs associated with
the stay. Patient costing is an important component of local decision-making. Nationally,
it is used to respond to analytical questions and develop various products, including
case mix weights and the
Patient Cost Estimator. We are working with data providers
to ensure the data is the best it can be.

This year, a data quality assessment framework was
developed for Nova Scotia and implemented in that province.
CIHI worked closely with the IWK Health Centre to assess
its data using the 5 dimensions of our quality framework
and to provide feedback and guidance for moving forward. Better data means better
results.

Decision-making supportGoal 2: Support population health and health system
decision-making

A rolling picture

CIHI’s Analytical Plan provides a big picture view of CIHI’s new reports and indicators. The goal
is to ensure that our work is aligned with our strategic directions, relevant to the needs of our
stakeholders and transparent to our partners.

We’ve been looking at the big themes of patient experience, quality and
safety, outcomes and value for money. And now we’re beginning to look
at specific populations identified by our stakeholders: seniors, children
and youth, recipients of mental health and addictions care, and First
Nations, Inuit and Métis. It’s exciting because the research we’ve done to develop our new
strategic plan tells us that this is what our stakeholders want and need.

We’re hearing a lot about knowledge translation/exchange. How does that fit in?

A number of new initiatives are under way, including providing more relevant information
for local use, conducting webinars and hosting forums to promote dialogue. For example,
we developed 2 interesting reports that looked at the connections between strong primary
health care and hospital use. CIHI analysts and regional office staff collaborated to offer
virtual seminars for stakeholders in British Columbia, Alberta and Saskatchewan to look
at how the results could be understood and applied in their provinces.

What’s the end
goal?

We want to keep our stakeholders informed about where we’re going and ensure they can
help shape our reports, and then use the knowledge once the analysis is done. The more
we do that, the more relevant and helpful we’ll be.

Happy birthday, NHEX!

In October, CIHI celebrated the 40th anniversary of the National Health Expenditure
Database (NHEX) with a birthday bash in Ottawa. The Economic Club of Canada and CIHI
hosted close to 150 people who listened to a lively conversation about curbing Canada’s
health spending growth. The Globe and Mail’s André Picard moderated the panel and also
wrote a column reflecting on 40 years of health expenditures. The panel included

Don Drummond, Adjunct Professor, School of Policy Studies, Queen’s University

Dr. Cindy Forbes, President, Canadian Medical Association

Dr. David Naylor, physician, medical researcher and immediate past president, University of Toronto

Brent Diverty, Vice President, Programs, CIHI

NHEX allows us to look back in order to look forward, with 4 decades of valuable information to draw on.

There are more spending discrepancies within Canada’s
provinces than between Canada and other countries.

Don Drummond, Adjunct Professor,
School of Policy Studies, Queen’s University

If we truly want to deliver better care, we need to be prepared
to invest in care provided in the community, better management
of chronic illnesses as well as long-term care, which will free up
hospital beds in the acute-care system.

Key findings show that income-related inequalities widened over the past decade for
3 indicators: Smoking, Self-Rated Mental Health and Chronic Obstructive Pulmonary
Disease (COPD) Hospitalization for Canadians Younger Than Age 75. This type of data
will support jurisdictions as they look to improve health among all population groups.

The interactive tool provides an additional layer, allowing stakeholders to drill down and explore the data by province and sex. Initial feedback on and traffic to the web
tool demonstrate its value.

Data. Impact. Solutions.

In Canada, the number of emergency department visits and hospitalizations by children
and youth with a mental disorder continues to increase, despite a lack of evidence that
mental disorders are becoming more prevalent.

In May 2015, CIHI released Care for Children and Youth With
Mental Disorders at a
policy symposium hosted in conjunction with the Mental Health Commission of Canada,
Children’s Mental Health Ontario and the Ontario Hospital Association. The event was
attended by a variety of stakeholders who could use this data, including doctors and nurses,
youth advocates and families, and policy-makers and health care system planners. This
report describes hospital service use, for both emergency department visits and inpatient
hospitalizations, as well as use of mood/anxiety or antipsychotic medications. This release
has been used by our partners, stakeholders and Canadians to inform policy development,
build recommendations, facilitate an ongoing dialogue and support quality improvement
initiatives, in both hospitals and the education sector.

CIHI later worked with our partners at the Mental Health Commission of Canada
and Children’s Mental Health Ontario to release an update to our
Child and youth mental health in
Canada infographic:

Getting the right people in the room

Convening and knowledge sharing is about working with stakeholders to develop a
deeper understanding of how to use health care data and information to support their
decision-making. Perhaps our biggest contribution may be getting the right people in the
room to support knowledge translation/exchange.

Kathleen Morris, Vice President, Research and Analysis, reflects
on this important work:

Can you share some successes from the
past year?

There are many, so I’ll tell you about just a few of them!
CIHI’s Health System Performance (HSP) Schools — this
year offered in Alberta and Saskatchewan — continued
to make an impact. The schools help those working in the
field build their knowledge of performance measurement and use data to take
action for health system improvement. We also stay in touch with those who
participated in earlier schools, using web conferences and a Community of
Practice forum to enable them to share what they learned and stay connected.

Another initiative used a virtual approach to connect thought leaders with people across the country who were interested in understanding high users of health care services.
Interactive discussions helped identify the practical implications of using different
approaches to address this challenge.

What about the HSU?

We collaborated with Canada Health
Infoway to welcome 125 delegates to the 2-day
Health System Use Summit in
February 2016. The event showcased the value of
health analytics — both at the front line and
for informing system decisions — and initiated
a lot of discussion on how to move this agenda
forward. In fact, some of the best lessons came
from those outside of health care. Really, we
were hosting a conversation, not a conference.
Now we want to keep it going.

Meaningful data

It’s not just about health care. By taking a broader health system approach, we start to see the connections between inputs, outputs, outcomes and social determinants. CIHI is working hard
to integrate performance reporting
initiatives to do just that.

Here are a few highlights:

We developed a
framework to guide our understanding of how to measure performance.
The framework starts with an overall view of the health system and cascades down to
hospitals and even long-term care facilities. This helps us understand what it means to
measure performance at these levels, too.

The private Your Health System: Insight tool that launched in March 2015 allows users
to slice and dice their information in customized ways. Health care providers and analysts
can use this tool to dig deeper into indicator results.

In a major enhancement to the Your Health System: In
Depth web tool, we added facility-level
reporting for 9 long-term care indicators
and 8 contextual measures using data from
2010 onward.

Workshops across the country are helping to build local capacity to use our data and
web tools for measuring and monitoring health system performance at the local level

We don’t want to just flood the
market with massive amounts of data. We
want to provide more targeted, meaningful
information.

The patient’s perspective

Patient-reported measures provide insight into the effectiveness of care from a patient’s perspective, providing essential information to support patient-centred care. Through
standardized data collection, jurisdictions will be able to access comparative performance
measurement reports that support their quality improvement efforts.

Patient-reported experience measures (PREMs) capture the patient’s views about care
experiences. Data is collected using a standardized survey, and our CPERS database is
ready to receive data from facilities across Canada. To date, Manitoba, Alberta, Ontario and
New Brunswick are on board and will soon be able to see comparative reporting on measures
such as overall satisfaction, care coordination and other measures of quality from the
patient’s perspective.

Canada does not currently have a standardized program for the routine collection and use of patient-reported outcome measures (PROMs). CIHI is taking a leading role in developing
a pan-Canadian strategy to enable comparable information, including standards for data
collection and reporting. Demonstration projects have been launched in the priority clinical
areas of renal care and hip/knee replacement surgery.

CIHI has also linked with international sources to see what we can learn. We have shared our work with people from the New South Wales Bureau of Health Information as well as
the National Health Performance Authority, both in Australia.

A giant puzzle

CIHI’s population grouping methodology combines the clinical information available for an
individual over multiple years and across health sectors, and then uses it to create a clinical
profile and assign indicators of health risk and burden of illness. Health regions can then
better understand — and plan for — the burden of disease in their region.

In 2015, we shared 2 initial versions of this grouper with a few Canadian stakeholder
representatives who are familiar with the use of population grouping methodologies.
Their feedback on the methodology was very positive, and we are looking forward to
releasing a revised version to a much wider audience of stakeholders in 2016–2017.

International spotlight

Comparing health systems from different countries can help us understand how well Canada’s systems are working. International comparisons provide broader context for benchmarking
and peer learning. As a leading partner with the Organisation for Economic Co-operation and
Development (OECD), CIHI updated its web tool that compares Canada and its provinces with 34 OECD
countries on 50 indicators of health and health
care. A report focusing on diabetes explored
Canada’s results on prevention and management
of the disease.

In cooperation with The Commonwealth Fund, CIHI released results from the 2015 edition of The Commonwealth Fund
International Health Policy Survey, which focused on the
experiences of primary care physicians in 10 developed countries. The release included
a companion report that highlights the Canadian story and examines how experiences
vary, both across the country and relative to other countries.

Have you met Maureen?

Since 2000, CIHI has been a co-sponsor of Canada’s only national e-Health Conference and Tradeshow. The event brings together users and system suppliers and highlights the important
role that CIHI plays in supporting the greater e-health agenda. More than 1,500 delegates
attend each year.

At this year’s conference, CIHI introduced “Maureen” to highlight the way an individual and her health data move across the entire system. This virtual persona helped delegates look at how
data captures the type of care being received; how it can be shared across the continuum of
care; and how it can be used for health analytics at the clinical, facility and system levels. This
is all part of the “collect once, use many times” concept that CIHI’s national data standards
and integrated reporting systems are championing. We are working together to ensure we are
talking to one another in a coordinated, meaningful way.

Image Description: Meet Maureen. A retired and active 62 year old. On a hiking trip, she experienced a fall that resulted in a fractured right hip. Her injury sent her on a journey through the health care system.

Excellence in allGoal 3: Deliver organizational
excellence

A staff snapshot

93% of CIHI staff participated in the biennial employee survey, giving us a clear
snapshot of our staff’s views. The survey allows us to identify areas of improvement
based on employees’ perceptions. We are then able to provide formal feedback and
measure future progress against the provided baseline.

Results continued to paint a picture of a highly effective organization, with overall
engagement at 78% and enablement at 76%, exceeding both public-sector and
high-performing organization norms.

We know that engaged and enabled employees contribute to our success.

Challenge. Change. Create.

CIHI launched its first-ever Innovation Month for staff in April 2015. Speakers, panel
discussions, analyst forums, videos and online quizzes sparked conversations among
employees about changing the way we work to be more innovative in what we do and
how we do it.

It wasn’t about being the next individual to develop a brilliant idea — it takes a team to
generate, filter, implement, champion and connect ideas to create meaningful change.
Innovation Month is an opportunity to challenge each other to think outside the box,
experiment and learn. Innovation is key to meeting our clients’ needs — and each
other’s needs, as well.

Digital deep dive

CIHI’s digital strategy is all about business transformation. We want to understand
our stakeholders’ digital information consumption and interaction preferences.
By collaborating with them, we will be better prepared to design and deliver
relevant and timely digital assets. To remain current, we will be guided by evolving
technology trends.

As part of the digital transformation project, we are redeveloping
our principal website to deliver a seamless user experience
with our information and tools. We are actively engaging with
our stakeholders as part of the iterative design process
to provide an integrated information-centric environment.

Board committees

Finance and Audit Committee

The Finance and Audit Committee reviews and recommends approval of the broad financial
policies, including the yearly operational plans and budget, and reviews the financial position
of the organization and our pension plan. This committee also formulates recommendations
on the financial statements, the public accountant’s report and the appointment of the
forthcoming year’s public accountants, and it provides direction and review of our internal
audit program.

Governance and Privacy Committee

The Governance and Privacy Committee assists the Board in improving its functioning,
structure, composition and infrastructure. This committee exercises the powers and duties
of the nominating committee, in accordance with our bylaw. The Governance and Privacy
Committee also reviews and makes recommendations on the direction of the privacy program,
and on our privacy and data protection practices.

Looking ahead

Through extensive consultation, we have reflected on who we are and our unique role in
Canada’s health sector. We continue to believe that better data contributes to better decisions,
ultimately improving the health of Canadians. And we are committed to making our information
more accessible and easier to use.

Working collaboratively with our stakeholders is critical to achieving our goals. Our strategic plan highlights the importance of responding to our stakeholders’ needs quickly, with
innovative tools and approaches. We are committed to fostering these relationships.

Ultimately, the plan will drive health system transformation and improvement across the
continuum of care.

CIHI’s future centres around 3 strategic goals and a commitment to stakeholders. As we look ahead, we want to share our thinking behind each of these goals, as well as our priorities for
the next 5 years:

1 Be
a trusted source of standards and quality data

It’s about having the right data for our stakeholders’ work and our work.
We will collect data in priority areas, driven by the priority themes of our
stakeholders. And we will continually review our data holdings to ensure
they meet the needs of our stakeholders.

Over the next 5 years, CIHI will

Increase the use of health data standards to achieve quality data

Make data collection easier and improve timeliness

Close the data gaps in priority areas

Make data more accessible

2
Expand analytical tools to support
measurement of health systems

We want our reporting tools, methods and information to prompt our
stakeholders to make improvements in health care, health system
performance and population health. It’s about enriching our information
infrastructure to enrich the health of Canadians.

We want our stakeholders to put CIHI’s products and services into action.
And we want to give them the tools they need to do that. We are going
to engage the public as well, to truly drive health system improvements.

Over the next 5 years, CIHI will

Produce analyses that contribute new information and insights, working
with external partners and with intended end-users to create a culture
of co-development

Engage with stakeholders to enable better use of health data
and information

Provide customized products and services to support local
decision-making needs

As our strategic plan unfolds, there will be exciting changes and new
initiatives at CIHI. We have defined our role, we have built a solid
foundation and we have engaged our stakeholders. The course is
set. It’s going to be an exciting journey!

Over the next 5 years, our focus is
clear:

Health system performance themes

Patient experience

Quality and safety

Outcomes

Value for money

Priority populations

Seniors and aging

Mental health and addictions

First Nations, Inuit and Métis

Children and youth

CIHI’s strategic plan at a
glance2016 to 2021

Vision

Better data.
Better decisions.
Healthier Canadians.

Mandate

Deliver comparable and actionable information
to accelerate improvements in health care,
health system performance and population
health across the continuum of care

Strategic goals

Be a trusted source of standards and quality
data

Deliver more timely, comparable and accessible data across the health continuum

Expand analytical tools to support measurement
of health systems

Deliver reporting tools, methods and
information that enable improvements
in health care, health system
performance and population health

Produce actionable analysis and accelerate its
adoption

Collaborate with stakeholders
to increase their ability to use
data and analysis to accelerate
improvements in health care,
health systems and the health
of populations

Priority themes and populations

Themes

Patient experience

Quality and safety

Outcomes

Value for money

Populations

Seniors and aging

Mental health and addictions

First Nations, Inuit and Métis

Children and youth

Foundation

Our people

Stakeholder engagement and
partnerships

Privacy and security

Information technology

Values

Respect

Integrity

Collaboration

Excellence

Innovation

Leading practices

This section provides an overview of our operations
and an explanation of our financial results.

Who does what

Management prepared the financial statements and is responsible for the integrity and
objectivity of the data in them. This is in accordance with Canadian accounting standards
for not-for-profit organizations.

CIHI designed and maintains internal controls to provide reasonable assurance that the
financial information is reliable and timely, that the assets are safeguarded and that the
operations are carried out effectively.

The Board of Directors carries out its financial oversight responsibilities through
the Finance and Audit Committee (FAC), which is made up of directors who are not
employees of the organization.

Our external auditors, KPMG LLP, conduct an independent audit in accordance with
Canadian generally accepted auditing standards and express an opinion on the financial
statements. The auditors meet on a regular basis with management and the FAC and
have full and open access to the FAC, with or without the presence of management.

The FAC reviews the financial statements and recommends their approval by the
Board of Directors. For 2015–2016 and previous years, the external auditors have
issued unqualified opinions.

Disclaimer

This section includes some forward-looking statements that are based on current
assumptions. These statements are subject to known and unknown risks and
uncertainties that may cause the organization’s actual results to differ materially
from those presented here.

Funding

CIHI receives most of its funding from the
provincial/territorial ministries of health and the
federal government.

The proportion coming from these 2 levels of
government has evolved over time but has been
stable over the last few years.

Our total annual source of revenue averaged $103.1 million between2012–2013 and
2015–2016. This pays for our ongoing program of work related to our core functions and
priority initiatives.

Includes contributions from
provincial/territorial
governments for special-purpose
programs/projects as well as
lease inducements for
2012–2013, 2015–2016 and 2016–2017 (planned).

Federal government —
Roadmap/Health
Information Initiative

83.0

77.7

79.4

78.5

77.7

78.7

Provincial/territorial
governments —
Core Plan

16.7

17.1

17.4

17.4

17.4

17.4

Other†

8.5

4.9

6.7

5.1

5.7

5.4

Total annual
revenue

108.2

99.7

103.5

101.0

100.8

101.5

Funding agreements

Since 1999, Health Canada has significantly funded
the building and maintenance of a comprehensive and
integrated national health information system. Funding
has come through a series of grants and contribution
agreements referred to as the Roadmap Initiative or
Health Information Initiative (HII).

A 3-year HII funding agreement was put in place with Health Canada in 2012–2013.
It included a phased-in 5% reduction over 3 years. As a result, annual base funding
went from $81.7 million in 2012–2013 to $77.7 million in 2014–2015.

The HII agreement was renewed for 2015–2016 at the same level as for 2014–2015;
it was later amended to include a new 5-year program of work on prescription drug
abuse, for a total of $4.28 million over the 5 years.

The funding for 2016–2017 reflects an additional 1-year extension of the existing funding agreement with Health Canada at the same funding level.

The first year in the table includes funding from the Roadmap agreement for $1.3 million. The agreement ended in 2012–2013.

The results presented for 2013–2014 and 2014–2015 reflect an approved carry
forward of $1.6 million, related to a few key projects planned for 2013–2014 but
completed in 2014–2015.

Through bilateral agreements, the provincial/territorial ministries of health continued to fund our Core Plan (a set of products and services provided to the ministries and identified health
regions and facilities).

These agreements provided $17.4 million in funding in 2015–2016.

They have been renewed for 1 year, through 2016–2017, at the same funding level.

Delays in certain key project activities produced savings that will be carried forward to 2016–2017 ($800,000), as approved by Health Canada.

Capital investments

Capital
investments ($ millions)

2012–2013 Actual

2013–2014 Actual

2014–2015 Actual

2015–2016 Planned

2015–2016 Actual

2016–2017 Planned

Furniture and office
equipment

0.1

— none

— none

— none

0.1

0.1

Computers and
telecommunications equipment

1.8

2.3

1.2

1.3

1.1

1.2

Leasehold
improvements

0.4

0.1

0.1

0.2

0.2

0.2

Total capital
investments

2.3

2.4

1.3

1.5

1.4

1.5

Acquisition of capital assets, 2015–2016: $1.4
million

This is a minimal increase compared with 2014–2015 and slightly lower than planned
capital spending.

Capital investments for 2015–2016 were slightly less than planned due to cost savings as well as some planned investments that were not required.

Capital investments from year to year are based on an ongoing roadmap of planned
acquisitions and upgrades to ensure that equipment and software is robust and
adequate to meet changing operational demands.

Pension plans

CIHI Pension Plan

Our registered defined benefit plan offers our employees an annual retirement income
based on length of service and final average earnings and is being funded by both
employees and CIHI.

As of March 31, 2016, the plan assets were $150.6 million for 989 members, 70% of whom are active participants.

In addition, we supplemented the benefits of employees participating in the plan who are affected by the Income Tax Act’s maximum pension limit.

Wind up

Following the November 2014 decision approved by CIHI’s Board of Directors, the defined benefit and supplementary retirement plans were wound up effective December 31, 2015.

Beginning January 1, 2016, CIHI employees joined the Healthcare of Ontario Pension Plan (HOOPP), the British Columbia Municipal Pension Plan or the Group RRSP.

In February 2016, the supplementary retirement plan was settled.

Contributions (CIHI Pension Plan)

Contributions to the CIHI Pension Plan are determined by actuarial calculations and
depend on employee demographics, turnover, mortality, investment returns and other
actuarial assumptions.

CIHI’s and employees’ contributions are pooled, invested and professionally managed by Manulife Financial.

The primary goal of the minimum risk investment strategy adopted in 2014 is to reduce the fluctuations in the financial position of the plan and to provide its members and
beneficiaries with the stipulated level of retirement income upon the wind up of the plan.

To exercise effective management and stewardship of the investment funds, the investment manager’s performance and the investment policy are reviewed annually.

Actuarial valuations (CIHI Pension Plan)

2 actuarial valuations are prepared at different times and use different methodologies and assumptions:

For accounting purposes (see note 7 of
the financial statements)

For funding purposes (this is also used
for regulatory purposes and management of
the plan)

The most recent actuarial valuation for funding purposes was prepared as of
January 1, 2014. In accordance with regulatory requirements, a wind-up valuation
report as of December 31, 2015, will be submitted to the Financial Services
Commission of Ontario in June 2016.

Internal audit program

Our internal audit program

Provides independent and objective assurance to add value to and improve our operations

Helps us accomplish our objectives by bringing a systematic, disciplined approach that both evaluates and improves our control and governance processes

Is prepared using a risk-based methodology that targets our audit resources at areas of highest risk, significance and value for the organization

In 2015–2016, activities included

An audit of procurement and payment compliance and controls

Penetration testing and vulnerability assessments of the ITS network, server infrastructure and selected applications

An audit of access rights by staff and consultants to CIHI networks and databases

An internal audit of ISO 27001 version 2005 and a certification audit of ISO 27001
version 2005

A compliance audit of a third-party data recipient regarding CIHI’s Data Request Form and Non-Disclosure/Confidentiality Agreement

We developed action plans to address the areas for improvement that were recommended by
the consultants we contracted to specifically perform these activities.

In 2016–2017, the focus of the internal audit program continues to be on information security and privacy. As well, we will initiate an internal audit on payroll and benefits.

Risk management activities

The goal of CIHI’s risk management program is to foster reasonable risk-taking based on
risk tolerance. CIHI’s approach to risk management is to proactively deal with future potential
events through risk mitigation strategies. This risk management program serves to ensure
management excellence, to strengthen accountability and to improve future performance.
It supports planning and priority-setting, resource allocation and decision-making.

CIHI is committed to focusing on corporate risks that

Cut across the organization

Have clear links to achieving our strategic directions

Are likely to remain relevant for the next 3 to 5 years

Can be managed by the senior leadership of CIHI

CIHI’s Risk Management Framework consists of the following 4 cyclical processes that
help us achieve our strategic directions:

CIHI’s Risk Management Framework

Achieving our strategic goals

Monitor and communicate

Review Framework

Executive/Board oversight

Risk managegment reporting

Establish framework

Policy framework

Governance framework

Process, methods, tools

Assess the risks

Identify strategic goals

Risk identification

Risk Assessment

Risk response and treatment

Key risk indicators

Strategy/action plans

Risk champions

Achieving our strategic goals

Assess the risks

Identify strategic goals

Risk identification

Risk assessment

Establish framework

Policy framework

Governance framework

Process, methods, tools

Monitor and communicate

Review framework

Managerial/board oversight

Risk-management reporting

Risk response and treatment

Key risk indicators

Strategy/action plans

Risk champions

Risk management activities for 2015–2016

The executive management team assessed a number of key risks that could prevent CIHI
from achieving its strategic directions based on their likelihood of occurrence and their
potential impacts. 4 of these risks were identified as corporate risks due to their high level
of residual risk (risk level after considering existing mitigation strategies).

Remaining relevant

With the growing trend to increase access to health data, current and new organizations
and groups are starting to integrate health information to support system management and
research. Consequently, the need for national/pan-Canadian data could become less relevant
as jurisdictions and regions have access to more granular and timelier data. CIHI addressed
this concern through its extensive stakeholder consultations to inform the new strategic
plan and by continuing to develop and implement strategies to improve the breadth and
coverage of CIHI data, as well as the timeliness of public reporting and analytical products
of priority data.

Health system use

Digital health solutions are being adopted more widely, which presents a challenge for health system use of data in the country. While the opportunity to access this “naturally occurring” data has many benefits, lack of data standardization in electronic records impedes our ability to fully make use of these new sources. As well, as services move from hospital settings to community-based clinics, data may be lost. This past year, CIHI worked to address these challenges by developing and sharing data content standards for priority systems such as physician electronic medical records and hospital information systems, by creating a data capture and reporting system suitable for community-based clinics and by raising awareness of health system uses of data with key leaders at the Health Analytics for Informed Decision-Making: Health System Use Summit in February 2016.

Funding

CIHI’s ability to meet existing operations and new priority initiatives continued to be a risk as
funding from our major stakeholders (federal/provincial/territorial governments) remained at
a constant level. By developing strategies with the Board of Directors and engaging Health
Canada and the provinces/territories, CIHI maximized its use of available funding toward new
priority investments by realizing efficiencies. As well, CIHI successfully transitioned to the new
pension plans and retirement savings plan and is currently working with its actuaries to wind
up the CIHI Pension Plan.

Building relationships

CIHI was at risk of losing stakeholder support as jurisdictions continued to increase their
focus on local solutions to address their data/decision-support requirements and as new
players emerged in health systems. To meet the needs of and to further engage stakeholders,
CIHI is developing a coordinated approach to stakeholder engagement and communication,
and we explored new relationships and partnerships (e.g., with vendors to raise awareness
of our standards and the implication for their work, with health quality organizations). CIHI also
acted in a convenor role to bring partners together to learn from one another while informing
a pan-Canadian direction on specific activities (e.g., PROMs Forum).